Zembala Michael O, Antonczyk Remigiusz, Niklewski Tomasz, Waszak Jacek, Pacholewicz Jerzy, Copik Izabela, Zembala Marian
Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia in Katowice, Silesian Center for Heart Diseases in Zabrze, Zabrze, Poland.
Interact Cardiovasc Thorac Surg. 2019 Mar 1;28(3):478-480. doi: 10.1093/icvts/ivy250.
Less-invasive left ventricular assist device implantation is becoming the technique of choice for implementation of new-generation heart pumps. The less-invasive technique is particularly useful for patients with a history of cardiac surgical procedures, such as coronary artery bypass grafting. Yet, in redo cases, severe pericardial adhesions may force experienced operators to opt for alternative outflow graft placement, such as in the descending aorta. We propose a surgical technique in which the left ventricular device is implanted through a limited thoracic incision, with the outflow graft anastomosed to the ascending aorta, avoiding collision with coronary bypass grafts. The key element of the proposed technique is a tunnel connecting 2 pleural cavities, in which the outflow graft is placed, entirely bypassing the pericardium.
微创左心室辅助装置植入正成为新一代心脏泵植入的首选技术。这种微创技术对于有心脏外科手术史的患者，如冠状动脉旁路移植术患者特别有用。然而，在再次手术的病例中，严重的心包粘连可能迫使经验丰富的手术医生选择其他流出道移植物放置位置，如降主动脉。我们提出一种手术技术，即通过有限的胸部切口植入左心室装置，将流出道移植物吻合到升主动脉，避免与冠状动脉旁路移植术移植物发生碰撞。所提出技术的关键要素是连接两个胸膜腔的隧道，流出道移植物置于该隧道内，完全绕过心包。
